Calcification of the aortic arch - Risk factors and association with coronary heart disease, stroke, and peripheral vascular disease

Context Calcium deposits in coronary and extracoronary arterial beds may in dicate the extent of atherosclerosis, However, the incremental predictive v alue of vascular calcification, beyond traditional coronary risk factors, i s not clearly established. Objective To evaluate risk factors for aortic arch calcification and its lo ng-term association with cardiovascular diseases in a population-based samp le. Design and Setting Cohort study conducted at a health maintenance organizat ion in northern California. Participants A total of 60 393 women and 55 916 men, aged 30 to 89 years at baseline who attended multiphasic health checkups between 1964 and 1973 an d for whom incidence of hospitalizations and/or mortality data were ascerta ined using discharge diagnosis codes and death records through December 31, 1997 (median follow-up, 28 years). Main Outcome Measure Hospitalization for or death due to coronary heart dis ease, ischemic stroke, hemorrhagic stroke, or peripheral vascular disease, as associated with aortic arch calcification found on chest radiograph at c heckup from 1964-1973. Results Aortic arch calcification was present in 1.9% of men and 2.6% of wo men. It was independently associated with older age, no college education, current smoking, and hypertension in both sexes, but it was inversely relat ed to body mass index and family history of myocardial infarction. In women , aortic arch calcification was also associated with black race and elevate d serum cholesterol level. After adjustment for age, educational attainment , race/ethnicity, cigarette smelting, alcohol consumption, body mass index, serum cholesterol level, hypertension, diabetes, and family history of myo cardial infarction, aortic arch calcification was associated with an increa sed risk of coronary heart disease (in men, relative risk [RR], 1.27; 95% c onfidence interval [CI], 1.11-1.45; in women, RR, 1.22; 95% CI, 1.07-1.38). Among women, it was also independently associated with a 1.46-fold increas ed risk of ischemic stroke (95% CI, 1.28-1.67). Conclusion In our population-based cohort, aortic arch calcification was in dependently related to coronary heart disease risk in both sexes as well as to ischemic stroke risk in women.